Is a 31-year-old female patient with a history of extreme health anxiety, presenting with palpable lymph nodes in the neck and left elbow, and a mole in her belly button that has recently changed, at risk for metastatic melanoma, considering her symptoms of abdominal fullness, altered stool, and existing diagnosis of Irritable Bowel Syndrome (IBS) and anxiety?

Differential Diagnosis

• Single most likely diagnosis
  • Health anxiety disorder: The patient's extreme health anxiety, conviction of having stage 4 metastatic melanoma despite a lack of concrete evidence, and focus on minor symptoms are all consistent with health anxiety disorder. The presence of IBS and anxiety also supports this diagnosis.
• Other Likely diagnoses
  • Benign lymphadenopathy: The patient's lymph nodes have been stable for 7 months, which suggests a benign cause. The recent appearance of new lymph nodes could be related to the ingrown hair or other minor infections.
  • Irritable bowel syndrome (IBS): The patient's symptoms of fullness under the left ribs, fluffy, flaky, and runny poop are consistent with IBS, which is also exacerbated by anxiety.
  • Dermatological conditions (e.g., seborrheic keratosis, benign nevus): The mole in the belly button has been present for 13 years and was previously deemed benign by a dermatologist. The recent changes could be due to a benign condition.
• Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
  • Lymphoma: Although the patient's lymph nodes have been stable, lymphoma is a potentially life-threatening condition that should be considered, especially given the presence of multiple lymph nodes.
  • Metastatic melanoma: Although the patient's mole is unlikely to be related to her other symptoms, melanoma can be aggressive and deadly if left untreated. A thorough evaluation of the mole and lymph nodes is necessary to rule out this diagnosis.
  • Other malignancies (e.g., gastrointestinal cancer): The patient's symptoms of fullness under the left ribs and changes in bowel habits could be indicative of a gastrointestinal malignancy, although this is less likely given the patient's age and lack of other symptoms.
• Rare diagnoses
  • Sarcoidosis: This condition can cause lymphadenopathy and gastrointestinal symptoms, but it is relatively rare and would require further evaluation to diagnose.
  • Other rare dermatological conditions (e.g., Merkel cell carcinoma): Although the patient's mole is unlikely to be malignant, other rare skin conditions could be considered, especially if the mole's appearance is atypical.